Proctitis
Table of Contents
What is Proctitis?
Proctitis is inflammation of the lining of the rectum, the lower section of the large bowel that sits just before the anus. It can appear suddenly and settle within days, or it can become an ongoing condition that affects comfort and daily life over a longer period.
Several different conditions can lead to proctitis, and each type is managed differently. The three most common types are infectious proctitis, which develops after a sexually transmitted infection, ulcerative proctitis, a form of ulcerative colitis limited to the rectum, and radiation proctitis, which can follow radiation therapy to the pelvic area. Proctitis can affect people of any age, and identifying the underlying cause is the first step toward the right treatment.
Symptoms of Proctitis
The most common symptoms of proctitis include diarrhoea or constipation, pain when passing a bowel motion, and a frequent or urgent need to open the bowels even when they are empty. Mucus or blood may appear in the stool or directly from the rectum, and many people notice lower abdominal cramping or discomfort in the anal area.
More general symptoms such as fever, unintended weight loss and nausea can also occur, particularly when the inflammation is more severe or linked to an underlying condition such as inflammatory bowel disease (IBD).
If you have bloody stools or heavy bleeding from your rectum and feel faint, dizzy or lightheaded, this may be a medical emergency. Seek immediate medical care or call triple zero (000) for an ambulance.
What Causes Proctitis?
Proctitis can develop for several different reasons, and the underlying cause shapes the treatment your gastroenterologist will recommend.
Sexually Transmitted Infections
Infectious proctitis is commonly linked to sexually transmitted infections such as gonorrhoea, chlamydia (including a strain known as lymphogranuloma venereum), genital herpes, syphilis and mpox. It typically develops after unprotected anal sex with a partner carrying one of these infections. Because the symptoms of infection related proctitis can closely resemble those of inflammatory bowel disease or other non-infectious causes, testing for sexually transmitted infections is an important early step, usually carried out before other investigations proceed.
Gut Infections and Bowel Conditions
Proctitis can also follow a gastrointestinal infection, including bacteria such as shigella, campylobacter or clostridioides difficile. Inflammatory bowel disease is another significant cause. Rectal inflammation is a common feature of ulcerative colitis, and it can occur less often in Crohn’s disease. Coeliac disease has also been associated with proctitis in some cases.
Radiation Therapy
Radiation therapy directed at the pelvic area, for example during treatment for prostate, bowel or gynaecological cancers, can cause radiation proctitis. This may appear as an acute reaction during treatment that settles once therapy finishes, or as a chronic condition that develops later and can be more persistent and harder to manage.
How is Proctitis Diagnosed?
Your gastroenterologist will begin by asking about your symptoms, bowel habits, and relevant medical or sexual history, followed by a physical examination that includes assessment of the anal area. This combination of history and examination provides important clues about the likely cause, and helps distinguish proctitis from other anorectal conditions with similar symptoms.
Further tests are usually needed to confirm the diagnosis and rule out other conditions, including some that can present in a similar way, such as haemorrhoids or an anal fissure. These tests may include a colonoscopy or flexible sigmoidoscopy to directly examine the lining of the rectum and take a small tissue sample, known as a biopsy, for laboratory analysis. Stool tests, blood tests and imaging such as a CT scan may also be requested, depending on your individual presentation.
If a sexually transmitted infection is suspected, testing will usually be arranged for a full range of STIs, including HIV, using a blood test and a swab taken from the rectum. Establishing the precise cause of your proctitis allows your gastroenterologist to recommend the most appropriate and effective treatment.
When to See Your Doctor
You should arrange to see your GP if you notice any of the symptoms of proctitis described above, particularly a change in your usual bowel pattern, blood or mucus in your stool, or bleeding from your rectum. It is also important to see your doctor if you have had unprotected sex or are concerned that a partner may have a sexually transmitted infection.
Your GP will assess your symptoms and, where appropriate, refer you to a gastroenterologist for further investigation and specialist management. A referral from your GP is required to see a gastroenterologist at Queensland Gastroenterology.
If you have bloody stools or heavy rectal bleeding together with feeling faint, dizzy or lightheaded, this may be an emergency. Seek immediate medical care or call triple zero (000).
How is Proctitis Treated?
Treatment for proctitis depends entirely on the underlying cause, and your gastroenterologist will tailor a plan to your specific diagnosis. Staying well hydrated is a helpful general measure throughout treatment and recovery.
Treating Infection Related Proctitis
For proctitis caused by a bacterial infection, treatment usually involves antibiotic medicines targeted at the specific organism identified on testing. Viral causes, such as herpes, are treated with antiviral medicines. Because these infections are often sexually transmissible, you will be advised to avoid all sexual contact for at least seven days after starting treatment, or until your course of medicine is finished and your symptoms have resolved, whichever comes later. It is also important to avoid sexual contact with partners from the past six months unless they have been tested and treated where necessary. Confidential partner notification services are available to help with this process.
Treating Ulcerative Proctitis
When proctitis is caused by ulcerative colitis limited to the rectum, treatment centres on anti-inflammatory medicines, which may be given as a rectal preparation such as a suppository or enema, as a tablet, or as a combination of both. Most people notice improvement within a week of starting treatment, with fuller recovery over four to six weeks. If symptoms do not settle with standard anti-inflammatory treatment, your gastroenterologist may recommend a medicine that works by modifying the immune system, sometimes referred to as a biological therapy. Once you have recovered, your gastroenterologist will continue to monitor your rectum every six to twelve months to check that healing has been maintained.
Treating Radiation Proctitis
Mild radiation proctitis that develops during treatment often settles without specific therapy once radiation therapy finishes. When symptoms are more severe, ongoing, or associated with bleeding, medicines to reduce inflammation are used, and your gastroenterologist may also recommend an endoscopic procedure to treat bleeding areas of the rectal lining directly.
When a Procedure or Surgery is Needed
If symptoms of proctitis do not improve with medicines, a procedure or surgery may be required. Your gastroenterologist plays the central role in diagnosing proctitis, arranging the right investigations, and delivering medical treatment, including endoscopic procedures performed through a colonoscope. Where an operation is needed, for example for severe or complicated ulcerative proctitis, your gastroenterologist will coordinate a referral to a colorectal surgeon, who specialises in operative treatment of the bowel and rectum. This collaborative approach ensures you receive the right type of care from the right specialist at each stage of your treatment.
Possible Complications of Proctitis
Most cases of proctitis respond well to appropriate treatment, but ulcerative proctitis and chronic radiation proctitis can occasionally lead to complications. These include significant rectal bleeding, a hole forming in the bowel wall known as a perforation, and an abnormal channel forming between the bowel and nearby tissue, known as a fistula. Longstanding inflammation can also contribute to faecal incontinence, meaning reduced control over bowel motions. Severe complications may require urgent surgery and hospital admission, which is why ongoing follow up with your gastroenterologist is so important once a diagnosis of chronic proctitis has been made.
Can Proctitis Be Prevented?
Infectious proctitis linked to sexually transmitted infections can often be prevented through safe sex practices, including consistent condom use. Speak with your doctor or a sexual health service about strategies such as pre-exposure prophylaxis and post-exposure prophylaxis, which can reduce the risk of certain infections including HIV. Vaccination is also available for mpox and may be recommended depending on your individual risk factors. For proctitis related to inflammatory bowel disease, regular monitoring and adherence to your treatment plan is the most effective way to reduce the risk of flares and complications affecting the rectum.
Talk to Your GP About Proctitis
If you are experiencing symptoms of proctitis, speak with your GP, who can arrange an initial assessment and, where appropriate, a referral to a gastroenterologist at Queensland Gastroenterology.
Our specialist team supports patients with proctitis across Brisbane and South East Queensland, from investigations and diagnosis through to long-term management. Once you have your referral, please contact our practice directly to arrange an appointment.
For further reading on related bowel conditions, visit:
References
This information has been adapted from the following sources, as at 29/07/2026. It is intended for general patient education and does not replace individual medical advice from your GP or gastroenterologist.
Healthdirect Australia. Proctitis – symptoms, causes and treatment. Reviewed January 2025. Available at healthdirect.gov.au/proctitis.
Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM). Australian STI Management Guidelines for Use in Primary Care – Anorectal Syndromes. Available at sti.guidelines.org.au.
Gibson PR, Iser J. Inflammatory bowel disease. Australian Family Physician. 2005;34(4):233-237.
Daniel WJ. Anorectal pain, bleeding and lumps. Australian Family Physician. 2010;39(6):376-381.
